冠状动脉旁路移植术中胸腔镜与小切口直视获取胸廓内动脉的对比研究  

Comparison of Thoracoscopic and Minimally Invasive Direct Left Internal Thoracic Artery Harvesting in Coronary Artery Bypass Surgery

作　　者：张鲁锋[1] 傅元豪[1] 孟鲁豫 凌云鹏[1] 冯海波[1] Zhang Lufeng;Fu Yuanhao;Meng Luyu(Department of Cardiac Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院心脏外科,北京100191

出　　处：《中国微创外科杂志》2022年第11期859-863,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的对比胸腔镜和小切口直视获取左侧胸廓内动脉进行微创冠状动脉旁路移植手术的效果。方法回顾性研究2020年1月~2022年6月完成的胸腔镜辅助微创冠状动脉旁路移植术18例和小切口直视冠状动脉旁路移植术20例。2组年龄、左室射血分数、左室舒张末内径差异无统计学意义(P>0.05)。腔镜组使用胸腔镜器械获取左侧胸廓内动脉,应用微创心脏稳定器在左前外侧胸部小切口、非体外循环下完成冠状动脉旁路移植手术,包括左侧胸廓内动脉与冠状动脉前降支单支旁路移植16例,多支冠状动脉旁路移植2例。小切口组20例行左前外侧胸部小切口直视获取左侧胸廓内动脉,与前降支行旁路移植手术。结果腔镜组18例中16例成功获取左侧胸廓内动脉,1例转为肋间小切口直视获取左侧胸廓内动脉,1例胸腔镜获取血管时损伤远端,经肋间小切口直视修补后完成血管吻合。小切口组20例均成功获取胸廓内动脉并行旁路移植手术。与小切口组相比,腔镜组术后呼吸机使用时间短[(4.9±2.0)h vs.(6.5±2.3)h,t=-2.318,P=0.026],术后住院时间短[(4.5±0.9)d vs.(5.3±0.8)d,t=-2.859,P=0.007]。2组监护室停留时间、输血例数差异无统计学意义(P>0.05),出院前冠状动脉造影或CTA检查显示2组桥血管通畅率均为100%。结论胸腔镜获取左侧胸廓内动脉进行微创冠状动脉旁路移植术的效果与小切口直视技术相似,在缩短术后呼吸机使用时间以及住院时间方面具有优势。Objective To compare the clinical data of patients who underwent thoracoscopic or minimally invasive left internal thoracic artery(LITA)harvesting technique for coronary artery bypass grafting.Methods From January 2020 to June 2022,38 patients underwent minimally invasive coronary artery bypass surgeries.LITA was harvested with thoracoscopic(n=18)or minimally invasive instruments(n=20),respectively.There were no significant differences in age,left ventricular ejection fraction,and left ventricular end diastolic dimension between the two groups(P>0.05).In the thoracoscopic group,LITA was obtained with the thoracoscopic instrument,and the coronary artery bypass grafting was completed with the minimally invasive heart stabilizer through a small incision in the left anterolateral chest without cardiopulmonary bypass,including 16 cases of single bypass grafting between LITA and the anterior descending artery,and 2 cases of multi coronary artery bypass grafting.In the minimally invasive group,20 patients underwent bypass grafting with the anterior descending artery after obtaining LITA through a small anterolateral chest incision under direct vision.Results Among the 18 cases in the thoracoscopic group,LITA was successfully obtained in 16 cases,conversion to a small intercostal incision to obtain LITA under direct vision was required in 1 case,and the distal end was injured when obtaining the blood vessels under the thoracoscope in 1 case,with vascular anastomosis completed after repair through a small intercostal incision under direct vision.In the minimally invasive group,20 patients were successfully obtained LITA and underwent bypass grafting.Compared with the minimally invasive group,patients in the thoracoscopic group showed advantages in postoperative mechanical ventilation time(4.9±2.0 h vs.6.5±2.3 h,t=-2.318,P=0.026)and postoperative hospital length of stay(4.5±0.9 d vs.5.3±0.8 d,t=-2.859,P=0.007).There were no differences in perioperative red blood cell transfusion and ICU length of stay(P>0.05).Postopera

关 键 词：冠状动脉旁路移植术 胸腔镜技术 微创外科 左侧胸廓内动脉 

分 类 号：R654.2[医药卫生—外科学]